Tendesayi Kufa1,2, Waasila Jassat1, Cheryl Cohen1,2, Stefano Tempia2,3,4, Maureen Masha1, Nicole Wolter1,5, Sibongile Walaza1, Anne von Gottburg1,5, Nelesh P Govender1,5, Gillian Hunt1,5, Andronica Moipone Shonhiwa1, Joy Ebonwu1, Genevie Ntshoe1,6, Wellington Maruma1, Poncho Bapela1, Nomathamsanqa Ndhlovu1, Hlengani Mathema1, Motshabi Modise1, Liliwe Shuping1, Pinky N Manana1,5, David Moore7, Ziyaad Dangor7, Charl Verwey7, Shabir A Madhi8,9, Haroon Saloojee7, Heather J Zar10, Lucille Blumberg1. 1. National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa. 2. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. 3. Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 4. MassGenics, Duluth, Georgia, USA. 5. School of Pathology, University of the Witwatersrand, Johannesburg, South Africa. 6. School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa. 7. Department of Pediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa. 8. South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), Faculty of Health Science Johannesburg, University of the Witwatersrand, Johannesburg, South Africa. 9. Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science Johannesburg, University of the Witwatersrand, Johannesburg, South Africa. 10. Dept of Paediatrics and Child Health, Red Cross Children's Hospital, and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
Abstract
INTRODUCTION: We describe epidemiology and outcomes of confirmed SARS-CoV-2 infection and positive admissions among children <18 years in South Africa, an upper-middle income setting with high inequality. METHODS: Laboratory and hospital COVID-19 surveillance data, 28 January - 19 September 2020 was used. Testing rates were calculated as number of tested for SARS-CoV-2 divided by population at risk; test positivity rates were calculated as positive tests divided by total number of tests. In-hospital case fatality ratio (CFR) was calculated based on hospitalized positive admissions with outcome data who died in-hospital and whose death was judged SARS-CoV-2 related by attending physician. FINDINGS: 315 570 children aged <18 years were tested for SARS-CoV-2; representing 8.9% of all 3 548 738 tests and 1.6% of all children in the country. Of children tested, 46 137 (14.6%) were positive. Children made up 2.9% (n = 2007) of all SARS-CoV-2 positive admissions to sentinel hospitals. Among children, 47 died (2.6% case-fatality). In-hospital deaths were associated with male sex [adjusted odds ratio (aOR) 2.18 (95% confidence intervals [CI] 1.08-4.40)] vs female; age <1 year [aOR 4.11 (95% CI 1.08-15.54)], age 10-14 years [aOR 4.20 (95% CI1.07-16.44)], age 15-17 years [aOR 4.86 (95% 1.28-18.51)] vs age 1-4 years; admission to a public hospital [aOR 5.07(95% 2.01-12.76)] vs private hospital and ≥1 underlying conditions [aOR 12.09 (95% CI 4.19-34.89)] vs none. CONCLUSIONS: Children with underlying conditions were at greater risk of severe SARS-CoV-2 outcomes. Children > 10 years, those in certain provinces and those with underlying conditions should be considered for increased testing and vaccination.
INTRODUCTION: We describe epidemiology and outcomes of confirmed SARS-CoV-2 infection and positive admissions among children <18 years in South Africa, an upper-middle income setting with high inequality. METHODS: Laboratory and hospital COVID-19 surveillance data, 28 January - 19 September 2020 was used. Testing rates were calculated as number of tested for SARS-CoV-2 divided by population at risk; test positivity rates were calculated as positive tests divided by total number of tests. In-hospital case fatality ratio (CFR) was calculated based on hospitalized positive admissions with outcome data who died in-hospital and whose death was judged SARS-CoV-2 related by attending physician. FINDINGS: 315 570 children aged <18 years were tested for SARS-CoV-2; representing 8.9% of all 3 548 738 tests and 1.6% of all children in the country. Of children tested, 46 137 (14.6%) were positive. Children made up 2.9% (n = 2007) of all SARS-CoV-2 positive admissions to sentinel hospitals. Among children, 47 died (2.6% case-fatality). In-hospital deaths were associated with male sex [adjusted odds ratio (aOR) 2.18 (95% confidence intervals [CI] 1.08-4.40)] vs female; age <1 year [aOR 4.11 (95% CI 1.08-15.54)], age 10-14 years [aOR 4.20 (95% CI1.07-16.44)], age 15-17 years [aOR 4.86 (95% 1.28-18.51)] vs age 1-4 years; admission to a public hospital [aOR 5.07(95% 2.01-12.76)] vs private hospital and ≥1 underlying conditions [aOR 12.09 (95% CI 4.19-34.89)] vs none. CONCLUSIONS: Children with underlying conditions were at greater risk of severe SARS-CoV-2 outcomes. Children > 10 years, those in certain provinces and those with underlying conditions should be considered for increased testing and vaccination.
Authors: John Kubale; Angel Balmaseda; Aaron M Frutos; Nery Sanchez; Miguel Plazaola; Sergio Ojeda; Saira Saborio; Roger Lopez; Carlos Barilla; Gerald Vasquez; Hanny Moreira; Anna Gajewski; Lora Campredon; Hannah E Maier; Mahboob Chowdhury; Cristhiam Cerpas; Eva Harris; Guillermina Kuan; Aubree Gordon Journal: JAMA Netw Open Date: 2022-06-01